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Australian-first rural MIGS surgery a success

20/03/2018By Matthew Woodley
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Four patients from rural New South Wales underwent Minimally Invasive Glaucoma Surgery (MIGS) on Monday, the first time in Australia such a procedure has been undertaken outside a major metropolitan city.

The surgeries were performed at Broken Hill Base Hospital (BHBH) by glaucoma surgeon Dr Ashish Agar, a key member of the Prince of Wales Hospital (POWH)’s Outback Eye Service and one of the first ophthalmologists to perform MIGS in Australia. Agar told Insight early indications were that the surgeries were successful and that they represented major progress in the treatment of glaucoma in Australia.



This is a boon for equity of access to specialist medical services for people living in the bush.”
Dr Ashish Agar, glaucoma surgeon

“The list went really well and now there will be very little follow-up required. The Outback Eye Service team will be back in Broken Hill for simple follow-up visits with the four patients in a week, and then a month after that. Ordinarily, with traditional glaucoma surgery there is a much greater need for specialised follow-up care,” Agar said.

“The outlook from here is to build on yesterday’s success. We have already identified another two local patients that we will be looking to provide the surgery for later in the year.”

Three of the four surgeries were standalone MIGS, while the fourth patient underwent combined cataract MIGS. Under the current temporary MBS number that has been created for MIGS, which Insight understands was approved by the Medical Services Advisory Committee (MSAC), Medicare would have only covered the combined cataract MIGS procedure.

However, last month Federal Health Minister Greg Hunt directed MSAC to review the decision following a meeting with members from the Australian Society of Ophthalmologists, in which they argued to expand the scope of access to MIGS as a standalone procedure.

Long-term planning

According to Agar, who is also the director of the ophthalmology service at BHBH, Monday’s MIGS outreach clinic was the result of several months of planning from key stakeholders.

“Before now, rural and remote glaucoma patients could not access this advanced technology in their own communities, despite the fact that its outcomes can be transformational. This is a boon for equity of access to specialist medical services for people living in the bush,” Agar said.

In particular, Agar had worked closely with BHBH management to facilitate the use of the technology in the rural setting, while they had also been working closely with POWH for a number of years to build a unique special eye service at the hospital. Broken Hill Health Services director of medical services, Dr André Nel said the MIGS outreach clinic demonstrated the power of partnerships.

GLAUKOS
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“Bringing specialist medical services to the bush is a priority for Broken Hill Hospital and this exciting new development is testament to the dedication and hard work of our staff and the work of our partners at The Outback Eye Health Service,” Nel said.

“We are proud to be taking part in this revolutionary surgery on our patch. It paves the way for more ventures that will deliver exciting benefits to local patients.”

Aside from the co-operation between the two hospitals, Agar said the medical device company that created the Hydrus Microstent used in the

surgeries, Ivantis, had also been integral in enabling the operation.

“From the outset Ivantis has been exceptionally supportive in allowing our patients access to their technology,” Agar said.

“They have donated many of their devices to those who cannot afford them, including here in Broken Hill where all of the microstents are being provided free of charge to the patients. It’s a great example of the way industry and the health services can work together in the interests of community.”

SURGERY GALLERY


Conducting the first MIGS eye surgery in Broken Hill Hospital on patient Beryl Thomas was (from left) Glen Burgess (Managing Director of Ivantis), Dr Ashish Agar (Consulting Opthalmologist), Dr Claire Ruan (Eye Registrar) and Lee-Ann Howarth (Clinical Nurse Specialist, Operating Theatre).
Conducting the first MIGS eye surgery in Broken Hill Hospital on patient Beryl Thomas was (from left) Glen Burgess (Managing Director of Ivantis), Dr Ashish Agar (Consulting Opthalmologist), Dr Claire Ruan (Eye Registrar) and Lee-Ann Howarth (Clinical Nurse Specialist, Operating Theatre).

Dr Ashish Agar, patient Beryl Thomas, and Ivantis’ Glen Burgess.
Dr Ashish Agar, patient Beryl Thomas, and Ivantis’ Glen Burgess.

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